Abos Day #98 A

Front 1

In valgus extension overload of the elbow, which letter in Figure A corresponds to the typical location of osteophytes formation? 1-A; 2-B; 3-C; 4-D; 5-E

Back 1

Over time, the continuous impaction of the posterior-medial olecranon in the olecranon fossa can lead to chondromalacia and osteophyte formation.Ans4

Front 2

38yo former professional football player c/o longstanding L shoulder pain, multiple previous dislocations; now c/o sx of repetitive instability & "catching" whenever abd & ext rotates; PE (+) apprehension test & crepitus in the 90/90 position. MRI Fig A. Which of the following surgical tx to address his sx?

Back 2

1-Sup labrum ant to pos (SLAP) repair; 2-Open approach for BG of hum defect w/allograft; 3-Open repair of (HAGL) lesion; 4-Remplissage proced; 5-Arthroscopic Bankart repair and Remplissage proced:::chronic Bankart tear & engaging Hill-Sachs -> ant shoulder instability & engagement of the Hill-Sachs in the 90/90, Remplissage procedure is performed by advancing the infraspinatus tendon into the Hill-Sach's defect.Ans5

Front 3

25yo basketball player s/p ant shoulder dislocation during a game that is subsequentlyC R w/ tx. MRI will most likely show which of the following? 1-supraspinatus tear; 2-HAGL; 3-Long head of the biceps tear; 4-Sup labrum ant to pos tear; 5-Anteroinferior labral tear

Back 3

Acute traumatic shoulder dislocations in young athletes assoc w/ a high rate of anteroinferior labral tears. Acute traumatic shoulder dislocations in older pts (>40yrs) are assoc w/ concomitant RCT.Ans5

Front 4

Open ant shoulder stabilization failed 2x for an active 22yo. he had another episode of instability when reaching into the back seat while driving, weakness performing the physical exam maneuver in Fig A. MRI Fig B & C. What is next surgical treatment?

Back 4

1-Another course of PT; 2-Latarjet procedure; 3-Lesser tuberosity transfer; 4-Pec maj transfer; 5-Latissimus dorsi transfer:::Dx-recurrent shoulder instability & belly press weakness (+)subscapularis deficiency, Due to muscle atrophy and retraction, a direct repair subscapularis tendon is not likely to be effective, pec maj transfer -> lesser tuberosity to substitute for subscap, Latissimus dorsi transfer->supraspinatus and/or infraspinatus deficiency, Latarjet procedure (coracoid transfer to anterior glenoid) ant glenoid deficiency.Ans4

Front 5

18yo football player sustains an ant shoulder dislocation that is reduced on the field. When he c/o pos pain, you suspect a Hill-Sachs defect. Which of the following is the best radiographic view for identifying a Hill-Sachs defect? define 5 views

Back 5

Stryker notch:::view is best for ID'g a Hill-Sachs defect; “true” AP or Grashey shoulder view- "end on" view of the glenohumeral joint->Glenohumeral joint space, DJD, and proximal migration of humerus; Zanca view- (AC) joint anatomy, West Point view for Bony Bankarts

Front 6

pt undergoes an MRI arthrogram for recurrent shoulder instability. Based on the imaging, the surgeon feels that arthroscopic tx is contra-indicated and recommends open tx. What is the most likely dx? 1-(GLAD); 2-(HAGL); 3-(SLAP); 4-(ALPSA); 5-(PASTA)

Back 6

classic teaching is that HAGL lesions requires open repair of the capsule, whereas the other lesions listed are felt to be better addressed with an arthroscopic approach.Ans2

Front 7

23yo offensive lineman had an arthroscopic anteroinferior labral repair 1 yr ago for shoulder instability. He has continued to have recurrent instability. Below is the preoperative MRI x 1 yr ago. What is cause of the recurrent instability?

Back 7

1- Anteroinferior labral nonunion; 2-Unrecognized (HAGL); 3-Anteroinferior glenoid bone defect; 4- Engaging Hill Sachs defect; 5-Untreated SLAP lesion:::MRI (+) anteroinferior glenoid fracture (bony Bankart). This was not addressed at initial surgery as the patient only underwent a soft tissue Bankart repair, concomitant osseous defects. Soft tissue procedures have a high failure rate when glenoid bony deficiency >25% exists.Ans3

Front 8

35yo businessman c/o tingling and numbness in his fingers of both hands, mostly in the ring and small fingers, made worse with overhead activity. Neurologic exam and electromyography-nerve conduction study is nl. His cervical spine x-ray is shown in figure A. What is the most likely diagnosis

Back 8

1-C5-6 cervical HNP; 2-C6-7 cervical HNP; 3- b/l cubital tunnel syndrome; 4-b/l radial tunnel syndrome 5- thoracic outlet syndrome:::thoracic outlet space = clavicle, 1st rib, subclavius muscle, costoclavicular lig, anterior scalene muscle. It affects subclavian A, vein, lower trunk (C8 & T1) of the brachial plexus. neurological exam may reveal sensory changes -> ring, little finger, intrinsic weakness. xrays -> cervical ribs, BUT R/O Pancoast tumor or even be normal.Ans5

Front 9

The female athlete triad refers to those athletes with: amenorrhea, osteoporosis, and what other entity? 1. Eating disorder; 2. Stress fractures; 3. Ligamentous laxity; 4. Increased rate of ACL tears; 5. Hirsutism

Back 9

female athlete triad refers to the combo of disordered eating, 2^ amenorrhea and osteoporosis.Ans1